Specific Instructions

Table of Contents

Name and social security number (SSN).   If you file a joint return, enter only the name and SSN of the spouse whose information is being reported on Form 8915. If both you and your spouse are required to file Form 8915, file a separate Form 8915 for each of you.

Part I—Qualified Hurricane Distributions From Retirement Plans (other than IRAs)

Complete Part I if you made a repayment of a qualified hurricane distribution.

Line 4

At any time during the 3-year period after the date you received a qualified hurricane distribution, you can repay any portion of the distribution to an eligible retirement plan that is permitted to accept rollover contributions. You cannot, however, repay more than the amount of the original distribution. See Repayment of a Qualified Hurricane Distribution beginning on page 1 for details.

Enter on line 4 the amount of any repayments you made during 2009. Do not include any repayments you included on your 2008 Form 8915.

Example.

You received a $90,000 qualified hurricane distribution on August 7, 2006, from your 401(k) plan because of Hurricane Wilma. On July 1, 2009, you repay $30,000 to an IRA. You would enter the $30,000 repayment on line 4.

Line 5

If you have an amount on line 5, you may be able to carry this amount back to your 2006, 2007, or 2008 return and reduce the amount of tax. For more information, see Amending Form 8915 on this page.

Part II—Qualified Hurricane Distributions From Traditional, SEP, SIMPLE, and Roth IRAs

Complete Part II if you made a repayment of a qualified hurricane distribution.

Line 9

At any time during the 3-year period after the date you received a qualified hurricane distribution, you can repay any portion of the distribution to an eligible retirement plan that is permitted to accept rollover contributions. You cannot, however, repay more than the amount of the original distribution. See Repayment of a Qualified Hurricane Distribution beginning on page 1 for details.

Enter on line 9 the amount of any repayments you made during 2009. Do not include any repayments you included on your 2008 Form 8915.

Example.

You received a $60,000 qualified hurricane distribution on July 1, 2006, from your Roth IRA because of Hurricane Katrina. On June 1, 2009, you repay $30,000 to your Roth IRA. You would enter the $30,000 repayment on line 9.

Line 10

If you have an amount on line 10, you may be able to carry this amount back to your 2006, 2007, or 2008 return and reduce the amount of tax. For more information, see Amending Form 8915 on this page.

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